老年冠心病合并阻塞性睡眠呼吸暂停低通气综合征患者不良预后的影响因素  

Adverse cardiovascular outcomes in elderly patients with coronary heart disease and obstructive sleep apnea-hypopnea syndrome:an analysis on influencing factors

作　　者：邹晓 赵力博 高莹卉 丁啟迪 陈开兵 高燕 林俊岭[6] 刘霖 Zou Xiao;Zhao Libo;Gao Yinghui;Ding Qidi;Chen Kaibing;Gao Yan;Lin Junling;Liu Lin(Department of Cardiology,Second Medical Center,National Clinical Research Center for Geriatric Diseases,Chinese PLA General Hospital,Beijing 100853,China;Sleep Center of Peking University International Hospital,Beijing 102206,China;Sleep Center of Peking University People′s Hospital,Beijing 100044,China;Sleep Center of Affiliated Hospital of Gansu University of Chinese Medicine,Lanzhou 730000,China;Department of General Medicine,No.960 Hospital of Joint Logistics Support Force of PLA,Jinan 250031,China;Department of Respiratory and Critical Care Medicine,Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100124,China;Department of Respiratory and Critical Care Medicine,Second Medical Center,National Clinical Research Center for Geriatric Diseases,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]中国人民解放军总医院第二医学中心心血管内科,国家老年疾病临床医学研究中心,北京100853 [2]北京大学国际医院睡眠中心,北京102206 [3]北京大学人民医院睡眠医学中心,北京100044 [4]甘肃中医药大学附属医院睡眠中心,兰州730000 [5]解放军联勤保障部队第九六〇医院全科医学科,济南250031 [6]首都医科大学附属北京朝阳医院呼吸与危重症医学科,北京100124 [7]中国人民解放军总医院第二医学中心呼吸与危重症医学科,国家老年疾病临床医学研究中心,北京100853

出　　处：《中华老年多器官疾病杂志》2024年第4期246-250,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：军队保健专项科研课题(23BJZ27,22BJZ52);军队装备建设应用研究项目(LB20211A010013);军队实验动物专项科研课题(SYDW_KY[2021]04)。

摘　　要：目的探讨老年冠心病(CHD)合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者不良预后的发生情况及影响因素。方法采用多中心前瞻性队列设计,选择2015年1月至2017年10月经多导睡眠监测诊断为OSAHS且合并CHD的265例患者(≥60岁)为研究对象。收集患者人口学资料、临床特征、睡眠参数指标、血液化验指标,并随访至2020年12月,随访结局为主要不良心血管事件(MACE)。根据患者是否发生MACE,将患者分为MACE组(n=55)和非MACE组(n=210)。采用SPSS 22.0统计软件进行数据分析。根据数据类型,分别采用t检验、Mann-Whitney U检验或χ^(2)检验进行组间比较。采用Spearman相关分析老年CHD合并OSAHS患者MACE与各指标的相关性。采用多因素logistic回归分析老年CHD合并OSAHS发生MACE的影响因素。结果中位随访时间为43(5~72)个月,累积MACE发病率为20.8%(55/265)。与非MACE组比较,MACE组吸烟(41.8%和27.6%)、心房颤动(27.3%和14.3%)、慢性阻塞性肺疾病比例(92.0%和27.6%)及血小板体积分布宽度[PDW,(13.08±1.40)%和(12.47±1.54)%]显著增加;血红蛋白水平[(129.40±15.85)和(135.24±16.87)g/L]显著降低,差异均有统计学意义(均P<0.05)。Spearman相关性分析显示,老年CHD合并OSAHS患者MACE与年龄、吸烟史、饮酒史、PDW、总睡眠时间(TST)及心房颤动呈正相关(r=0.075,0.125,0.128,0.145,0.129,0.140;P<0.05);与血红蛋白水平呈负相关(r=-0.141;P<0.05)。多因素logistic回归分析显示,PDW(OR=1.304,95%CI 1.046~1.627;P=0.018)、TST(OR=1.274,95%CI 1.037~1.566;P=0.021)及血红蛋白水平(OR=0.975,95%CI 0.954~0.996;P=0.022)是老年CHD合并OSAHS患者发生MACE的独立影响因素。结论老年CHD合并OSAHS患者MACE发生率较高,PDW和TST是老年CHD合并OSAHS患者发生MACE的独立危险因素,血红蛋白水平则是其保护因素。Objective To investigate the occurrence and influencing factors of adverse outcomes in elderly patients with coronary heart disease(CHD)and obstructive sleep apnea-hypopnea syndrome(OSAHS).Methods A multicenter prospective cohort trial was conducted on 265 elderly patients(≥60 years old)diagnosed with OSAHS and CHD through multiple-channel sleep monitoring during January 2015 and October 2017.Baseline demographic data,clinical features,sleep parameters,and blood biochemical indicators were collected,and all subjects were followed up until December 2020 for the occurrence of major adverse cardiovascular events(MACE).Patients were divided into MACE group(n=55)and non-MACE group(n=210)according to whether MACE occured.SPSS statistics 22.0 was used for data analysis.Student′s t test,Mann-Whitney U test or Chi-square test was employed for intergroup comparison depending on data type.Spearman correlation analysis and multivariate logistic regression analysis were employed respectively to analyze the correlation of MACE occurrence with above indicators and influencing factors for the occurrence in elderly patients with CHD and OSAHS.Results During a median follow-up time of 43(5-72)months,the cumulative incidence of MACE was 20.8%(55/265).Compared with the non-MACE group,the MACE group had significantly larger proportions of smoking(41.8%vs 27.6%),atrial fibrillation(27.3%vs 14.3%),chronic obstructive pulmonary disease(92.0%vs 27.6%),higher level of platelet distribution width[PDW,(13.08±1.40)%vs(12.47±1.54)%],and obviously lower level of hemoglobin[(129.4±15.85)vs(135.24±16.87)g/L,all P<0.05].Spearman correlation analysis showed that the occurrence of MACE in elderly patients with CHD and OSAHS was positively correlated with age,smoking history,alcohol drinking history,PDW,total sleep time(TST),and atrial fibrillation(r=0.075,0.125,0.128,0.145,0.129,0.140;P<0.05),and negatively with hemoglobin level(r=-0.141;P<0.05).Multivariate logistic regression analysis indicated that PDW(OR=1.304,95%CI 1.046-1.627;P=0.018)

关 键 词：老年人 冠心病 阻塞性睡眠呼吸暂停低通气综合征 不良心血管事件 

分 类 号：R541.4[医药卫生—心血管疾病] R563.9[医药卫生—内科学]